Medicare Advantage Compliance Specialist

At RAM Health, our mission is to simplify the complexities of healthcare administration through innovative, technology-driven solutions. With a focus on changing the industry one plan at a time, we drive continuous innovation to help government-sponsored health plans improve performance and quality while reducing costs.

RAM Health - Health plan administration, simplified.

This position is 100% remote and allows you to live anywhere in the U.S. and work from your home office. RAM does not provide sponsorship for U.S. employment and candidates must be authorized to work in the U.S. All work must be done within the U.S.

The Compliance Specialist supports RAM Health’s Compliance Program by executing and overseeing core compliance monitoring activities in a complex, fast‑paced Medicare Advantage and Managed Medicaid environment. Reporting to the Chief Compliance Officer, this role is responsible for identifying and mitigating compliance risks through ongoing monitoring, regulatory interpretation, exclusion screening, and corrective action follow‑up. The Compliance Specialist develops and delivers high‑quality RCA/CAP documentation to clients, maintains current knowledge of federal and state regulatory requirements, and collaborates closely with internal departments to promote operational integrity and a strong culture of compliance across the organization.

Roles and Responsibilities

• Monitor for and interpret CMS regulations, sub-regulatory guidance, HPMS memos, CMS transmittals; assess operational impact(s); and ensure timely implementation of required changes for RAM Health’s multiple Medicare Advantage and Managed Medicaid plans.

• Coordinate client- and leadership-requested root cause analyses (RCA) and corrective action plans (CAPs); ensure timely resolution and monitor for effective implementation through documented follow-up
• Analyze monitoring data to identify trends, anomalies, or potential areas of non-compliance; provide actionable recommendations.
• Create and maintain tracking tools, reports, and dashboards for compliance monitoring and remediation follow-up.
  
• Assign, track, and monitor completion of all required compliance, Fraud, Waste & Abuse (FWA), and HIPAA privacy and security training for all employees and contractors.
• Conduct monthly Office of Inspector General (OIG) and General Services Administration (GSA) exclusion list screening for all RAM employees and vendors; investigate and escalate positive matches as appropriate.
• Support the Compliance Department in the development and maintenance of policies, procedures, and other compliance-related documentation.
  
• Maintain current knowledge of applicable federal and state regulations, including but not limited to: CMS Medicare Advantage and Medicaid Managed Care rules, HIPAA, and state-specific health plan requirements.
• Support and actively participate in compliance team functions including, but not limited to, compliance risk assessments, review and development of compliance policies & procedures, compliance monitoring work plan development, ongoing monitoring activities, Compliance Committee reporting, annual Medicare Parts C & D reporting, external audit readiness, and external audit support.
  
• Meet regularly with the Chief Compliance Officer to set priorities, ensure work efforts are aligned, and discuss issues and opportunities for improvement.

Qualifications

• 3-4 years of experience in healthcare compliance with specific experience in Medicare Advantage regulatory monitoring.
• Bachelor’s Degree from an accredited university or equivalent experience.
• Strong understanding of applicable laws, regulations, and standards impacting health plans (e.g., CMS, Medicaid, HIPAA, OIG).
• Experience managing Root Cause Analysis (RCAs) and Corrective Action Plans (CAPs).
• Familiarity with exclusion screening processes (OIG/GSA) and vendor oversight.
  
• Proficient writing expertise: ability to write effectively and succinctly, convey information clearly and concisely without ambiguity and in a logical coherent flow that guides the reader through the text.
• Ability to analyze data and facts and draw logical conclusions, sound decision making skills, and meticulous attention to detail.
• Demonstrated ability to perform at a high level in a fast‑paced, demanding compliance environment; this role requires a strong, self‑directed performer capable of managing complex responsibilities with consistency and precision.
  
• High degree of discretion in dealing with confidentiality of all compliance-related matters.
• Certification in Healthcare Compliance (e.g., CHC, CCEP).

Competitive Benefits Package

• 100% remote work culture with the ability to work within the U.S.
• Comprehensive health, dental and vision coverage for you and your family.
• 5 weeks paid vacation and holiday time off that respects your wellbeing.
• Invest in your future with traditional and ROTH 401k with company match.
• Protection under company-paid life insurance, AD&D and long-term disability coverage.
• Tuition reimbursement to further your education.
• Parental leave to support growing families.
• Employee assistance with resources for mental health, financial wellness and more.

Compliance: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations.

Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.

Note: This job description is intended to convey information essential to understanding the scope of the position and is not an exhaustive list of efforts, duties, responsibilities, or working conditions associated with it. Duties, responsibilities, and activities may change at any time with or without notice.